Study of Pigtail Catheters for Tube Thoracostomy

Background

To study the efficacy and complications of percutaneous small bore pigtail catheters for tube thoracostomy.

Methods

50 cases of pleural effusion requiring drainage were enrolled in the study. Pigtail catheters of the size 9 to 12 F were used.

Results

The procedure was successful in 46/50 (92%) cases. Fibrinolytic therapy and pleurodesis was successful through these tubes. Complications included blockade in 4 (8%), small pneumothorax in 10 (20%) and chest pain at tube thoracostomy site requiring analgesics in 30 (60%).

Conclusion

Small bore pigtail catheters are safe, comfortable, cost effective and have few complications especially in loculated pleural effusions.Key Words: Pigtail catheter, Tube thoracostomy     

CT myelography for outpatients. An inpatient/outpatient pilot study to assess methodology

The diagnostic usefulness, limitations, and adverse reactions associated with computed tomographic myelography using metrizamide were assessed for broad outpatient application. The initial approach was to examine inpatients (n = 38) with low-dose metrizamide (100 mgI/ml). This low dose was believed less likely to be associated with side effects. They were then treated as if they were outpatients, with the liberties this entailed. The consequences of needle puncture were minimized by using a 25-gauge disposable needle. Thirty-four (89%) patients remained free of side effects after the procedure. Subsequently, this technique was extended to 42 outpatients, 38 (90.5%) of whom remained asymptomatic. For comparison, 170 mgI/ml was used in another 25 outpatients, who evidenced more symptoms. The potential medical, economic, and therapeutic benefits of obviating hospitalization by safer outpatient CT myelography seem clear.     

Acute appendicitis: high-resolution real-time US findings

High-resolution, real-time ultrasonography (US) with graded compression was used to evaluate 90 patients with clinically suspected acute appendicitis. US visualization of a noncompressible appendix was the primary criterion for a diagnosis of acute appendicitis. The overall sensitivity was 89%, the specificity was 95%, and the accuracy was 93%. When the results in women were analyzed separately (n = 49), the overall accuracy was 96%. Several important limitations of US scanning were encountered. There were three false-positive examinations in patients with a sonographically visible appendix whose symptoms spontaneously resolved. Another patient had a normal compressible appendix with a thin (2-mm), symmetric wall surrounded by ascites. There were three nondiagnostic studies (3%) due to inability to compress the cecum and right lower quadrant adequately because of exquisite tenderness (two patients) or massive ascites (one patient). When interpreted in light of the clinical examination, sonography should significantly reduce the rate of false-negative appendectomies, particularly in women.     

Corpus callosum and subcallosal-periventricular lesions in multiple sclerosis: detection with MR

Examination with magnetic resonance imaging of 40 patients with confirmed diagnoses of multiple sclerosis showed that corpus callosum involvement is common. Thirty percent of the patients had focal callosal lesions similar to those described in the pathology literature. Long, inner callosal-subcallosal lesions were found in 55% of patients. These lesions had signal characteristics similar to those of noncallosal periventricular lesions. Diffuse moderate to severe atrophy of the corpus callosum was noted in 40% of patients, with one exception concurrent with inner callosal lesions. The nature of the inner callosal lesions is not known, since these lesions are not typically described in the literature. These lesions may represent demyelination or increased water content and may be the precursor to atrophy that progresses from the ependymal surface toward the outer fibers of the corpus callosum.     

Detection of fetal central nervous system anomalies: a practical level of effort for a routine sonogram

To evaluate the efficacy of examining the lateral ventricular atrium, cisterna magna, and cavum septi pellucidi as a means of ascertaining that the development of the fetal central nervous system (CNS) is normal, a retrospective evaluation of the sonograms of 112 fetuses (15-39 weeks gestational age) with sonographically diagnosed CNS anomalies was performed. Malformations included in the study were diverse. The lateral ventricular atrium was enlarged (greater than 10 mm) in 99 (88%) fetuses. Of the remaining 13 fetuses, seven had an abnormal-sized cisterna magna (less than 2 mm or greater than 11 mm). These two measurements alone could be used to identify the presence of a CNS abnormality in 95%. Three of the six remaining fetuses exhibited gross abnormalities easily seen on the standard axial images obtained for biparietal diameter measurement. Although the cavum septi pellucidi was absent in a number of cases, its absence did not enhance sensitivity in the cohort examined. Prospective examination of 130 consecutive normal fetuses (15-40 weeks gestational age) was also performed. When specifically sought, the ventricular atrium was identifiable and measurable 99% of the time; the cisterna magna, 90% of the time; and the cavum septi pellucidi, 95% of the time. Because major CNS anomalies are uncommon and these measurements afford high sensitivity, an extremely low probability (0.005%) of abnormal brain or spinal cord development can be predicted if a normal-sized lateral ventricular atrium and cisterna magna are present. These results should not be construed as a license to underexamine fetuses for malformations. Rather, these measurements should serve as simple positive steps to assist in a difficult task.